Although segmental aqueous humor outflow has long been recognized, the details of this phenomenon are not well understood. In our study, both porcine and normal human TM exhibited distinct segmental distributions with regions of relatively dense, intermediate, and sparse Qdot labeling. Previous methods of evaluating segmental outflow have relied primarily on adsorption of ocular pigment, cationic ferritin, microspheres or labeled dextran beads to charged surfaces, presumably primarily ECM components, within the outflow pathway.
34 –37,39,50,51 (Hann CR, et al.
IOVS 2007;48:ARVO E-Abstract 2053; Overby DR, et al.
IOVS 2010;51:ARVO E-Abstract 1221). The overall segmental distribution patterns of perfused Qdots, which reflect active cellular uptake, appear to be similar to that in the charged ECM adsorption studies. Moreover, addition of a cell membrane stain, which stains the cell membranes without the need for macropinocytotic uptake into the cell, showed a similar segmental pattern of staining. Collectively, these studies support the argument that the segmental differences observed reflect outflow patterns rather than regional differences in adsorption or uptake. An anatomic relationship between intensely dextran-labeled areas and collector channel distribution has been observed.
35 Although we did not specifically evaluate this relationship, most of the regions labeled with Qdots and viewed en face were much larger and would encompass at least two to five separate collector channels. Therefore, the Qdot segmental labeling patterns seen in this study apparently reflected factors beyond the anatomic distribution of collector channels. The very high degree of segmentation shown in all these studies suggests that regional analyses will be necessary to correlate specific outflow pathway properties with outflow facility.
Versican levels generally showed an inverse segmental relationship to Qdot labeling in the TM. This suggests, but does not prove, a causal relationship in which high versican levels could provide higher resistance to outflow. Regional distributions of versican have also been found in mitral valves, where low versican expression was found in areas of tensile stress, while high versican expression was found in areas subject to compressive forces.
52 The results of perfusion with cytokines (TGFβ2, TNFα, and IL-1α) and the effects of physical manipulations (mechanical stretch, pressure increases, or both) show similar reciprocal relationships between outflow and versican levels or alternative mRNA splicing.
29,53,54 However, these modulation studies reflect overall TM versican levels, and it remains to be established how these are related to flow segmentation.
In human eyes, reducing versican levels by RNAi led to a loss of pillar-like staining in the JCT region and decreased outflow facility. Versican immunostaining was not completely eliminated in the versican-silenced TM, but complete abolishment was not expected, as versican mRNA is only knocked down and not completely eliminated. Moreover, endogenous versican that was already deposited in the ECM may not be turned over completely within the time frame of the perfusion experiment. Since versican binds many other ECM molecules, including fibronectin, CD44, fibrillins, and tenascins,
2 reduced versican levels likely disrupt TM ECM organization. Previous antisense studies have shown that depletion of versican increases tropoelastin mRNA levels, elastin deposition, and fiber formation in vascular smooth muscle cells.
26 Elastin assembly or other ECM component structures may therefore be altered in versican-depleted TMs. In the primary open-angle glaucoma (POAG) TM, there is a significant increase in the number of elastin-containing sheath-derived plaques in the JCT region.
55 –59 In the present study, we show that versican stains in a fibrillar pattern that is perpendicular to Schlemm's canal in normal human eyes. This pattern is similar to pillars of elastic fibers containing fibrillins and microfibril associated protein (MFAP)-1/2 described recently.
60 We hypothesize that these pillars of staining may represent actual flow channels through the TM as this pattern of staining predominated in densely Qdot-labeled regions. The versican molecules with their attached CS GAG chains may be essential to distributing the load within these channels to maintain their openness and prevent collapse. In versican-silenced human TM, there is a reduction of versican molecules and hence GAG chains. The versican molecules that remain are therefore subject to a higher load, which could lead to compaction, narrowing, and/or collapse of the outflow channels. The results presented here support this hypothesis, as there was loss of the pillar pattern of versican immunostaining in the JCT of versican-silenced TMs and H&E staining revealed disorganization in the tissue. Hyaluronidase pretreatment of tissue sections reduced hematoxylin staining in the JCT of versican-silenced eyes, suggesting that HA contributed, at least in part, to the altered staining patterns observed. These macromolecular changes in tissue structure were coincident with a decrease in outflow facility. Together, these observations argue that versican is a central component of the outflow resistance and may function to guide the proper structural organization of HA and other ECM molecules to facilitate open flow channels in the TM.
Lentiviral knockdown of versican caused opposite effects on outflow in human and porcine eyes. Versican silencing decreased outflow in human eyes but increased outflow facility in porcine eyes under identical experimental conditions. The reason for these opposite effects remains unclear. Prior outflow facility experiments where GAGase enzymes were perfused into primate and nonprimate eyes also produced differential responses.
6,14,19,61 –63 Nuanced variations in ECM structure or composition probably account for the observed reciprocal response in outflow facility shown here and the differential results between species in other studies. However, it is likely that, in all species, versican contributes to both physical outflow resistance and the three-dimensional structural organization of the ECM in the JCT region. Further studies are needed to accurately evaluate these differences in primate and nonprimate outflow resistance.
In areas of high Qdot labeling, reduced versican levels will also affect GAG chain concentration. Analysis of alternative splicing in areas of dense and sparse Qdot labeling showed that the V1 and V2 isoforms were relatively increased in areas of dense labeling, coincident with a reduction in total versican levels. By elimination, this suggests that V0, the longest versican splice variant, is more abundant in sparsely labeled areas. The V0 variant has 17 to 23 CS chains attached, whereas the V1 and V2 variants only have 12 to 15 and 5 to 8 CS attachment sites, respectively.
2 Therefore, in addition to reduced amounts of versican, areas with dense Qdot labeling may have a higher number of splice forms with fewer CS GAG chains. This suggests that CS GAG concentration is reduced in densely Qdot-labeled areas, which correlates with the increased outflow facility observed in ChGn-silenced eyes. Decreased CS concentrations caused by reduced versican would affect outflow resistance since the hydration capacity would be reduced, which in turn would lead to decreased resistance and increased aqueous humor passage through these areas. According to the same argument, in areas of sparse Qdot labeling, versican levels were increased and the versican V0 isoform, containing the largest number of CS chains, may be enriched. Of interest, in POAG eyes where outflow is reduced, CS chains were found to accumulate in the JCT region.
14,62 Changes in CS GAG chain concentration may also affect ECM protein–protein interactions, since chlorate, an inhibitor of GAG sulfation, induces atypical interactions between tenascin C and fibronectin.
19 Thus, regional alterations in versican levels, splice forms, or both will affect CS GAG chain concentration and may be a mechanism by which TM cells modify their ECM to homeostatically adjust outflow resistance.
Versican levels may also affect HA deposition into the ECM. Our previous study revealed variability in the staining pattern of HA-binding protein in human TM, which was suggestive of segmental flow.
19 Since versican assembles HA into aggregates,
26 a reduced amount of versican suggests that HA may also be depleted or disorganized in densely labeled areas. Conversely, in areas of sparse Qdot labeling, larger amounts of versican could assemble HA into aggregates, thereby increasing local HA concentration. A prior in vitro study showed that outflow decreased with increasing HA concentrations,
64 and intracameral application of HA to rat anterior chambers increased IOP.
65
To further investigate the role of CS chains in outflow resistance, we silenced the ChGn gene, which is an enzyme unique to CS GAG chain biosynthesis. In perfusion culture, we found an increase in outflow facility in both human and porcine anterior segments. This result supports previous observations using a chemical modifier of GAG biosynthesis, β-xyloside, or by enzymatic digestion of CS chains with chondroitinase ABC in porcine, bovine, and Cynomolgus monkey eyes.
10,16,19,66 Thus, a reduction of CS chains increases outflow facility in both human and porcine eyes. This observation correlates with reduced levels of versican in areas of dense Qdot labeling and with the contrary observations that increased CS concentrations are detected in POAG TM and intracameral administration of CS to the anterior chamber in rats causes IOP to increase.
14,62,67
In summary, segmental distribution of versican suggests that it is a central component of the outflow resistance and may be required to organize GAGs and other ECM components to facilitate open flow channels in the TM. This study represents a first step in identifying the molecular composition of outflow resistance and how specific ECM components can be manipulated to alter outflow facility.
Supported by National Institute of Health Grants EY003279, EY008247, and EY010572 (TSA); a Shaffer Award for Innovative Research from the Glaucoma Research Foundation, San Francisco, CA (KEK); and by an unrestricted grant to the Casey Eye Institute from Research to Prevent Blindness, New York, NY.
The authors thank Ruth Phinney (Oregon Lions Eye Bank) for coordinating human eye procurement, Carolyn Gendron for tissue sectioning, and Genevieve Long, PhD, for editorial assistance.